Discipline of Surgery, School of Medicine, James Cook University, Townsville, Queensland 4814, Australia.
Anticancer Res. 2010 Feb;30(2):601-7.
Anastomotic leak rates following colorectal anastomosis range from 4 to 26%, and the development of a leak is known to be correlated with worse prognosis after a curative resection for colorectal cancer. In addition, anastomotic leakage has been associated with increased mortality and risk of permanent stoma. While techniques to improve the leakage rates in colorectal surgery have been described, these have largely been through isolated case series. We sought to undertake an evidence-based approach to reviewing the use of such techniques.
A systematic review of the literature was performed, evaluating the current evidence for techniques to improve leakage following colorectal anastomosis.
There is Level I evidence to support the use of intra-operative leak testing, defunctioning ileostomy and drain tube insertion in the correct settings, including those associated with poor patient, disease and/or operative factors. There is no clear evidence to support the use of handsewn techniques, stapling techniques or laparoscopy over other techniques.
Reductions in morbidity and mortality from colorectal anastomotic leaks can be gained by performing intraoperative leak testing, defunctioning ileostomy and drain tube insertion in the correct settings. The technique for performing the anastomosis remains at the discretion of the surgeon and largely depends on experience, patient characteristics and the operative setting, rather than there being any clear evidence for one technique over another. New techniques and devices that overcome drawbacks in current practice are consistently being developed and tested, making further risk reduction in colorectal anastomosis of great future promise.
结直肠吻合术后吻合口漏的发生率为 4%至 26%，吻合口漏的发生与结直肠癌根治性切除术后的预后较差有关。此外，吻合口漏与死亡率增加和永久性造口风险增加有关。虽然已经描述了一些用于提高结直肠手术中漏率的技术，但这些技术主要是通过孤立的病例系列。我们试图采用循证方法来回顾这些技术的应用。
对文献进行了系统回顾，评估了目前关于改善结直肠吻合术后漏的技术的证据。
有一级证据支持在适当的情况下使用术中漏检、预防性回肠造口术和引流管插入术，包括与患者、疾病和/或手术因素较差相关的情况。没有明确的证据支持使用手工缝合技术、吻合器技术或腹腔镜技术优于其他技术。
通过在适当的情况下进行术中漏检、预防性回肠造口术和引流管插入术，可以降低结直肠吻合口漏的发病率和死亡率。吻合技术仍由外科医生自行决定，主要取决于经验、患者特征和手术环境，而不是有任何明确的证据表明一种技术优于另一种技术。克服当前实践中的缺陷的新技术和设备不断得到开发和测试，为结直肠吻合术进一步降低风险带来了巨大的未来前景。
